Acute kidney injury in patients with liver cirrhosis

Abstract

Background Acute kidney injury (AKI) is a common complication of cirrhosis and confers a poor prognosis. There are many different causes for the development of AKI among patients with cirrhosis. Aim The aim was to study the incidence of AKI in cirrhotic patients and the different causes of AKI among them. Patients and methods Our study was conducted on 900 cirrhotic patients who were investigated in order to detect the incidence and causes of AKI. They were subjected to thorough history taking, complete clinical examination, investigations including: blood urea and serum creatinine, serum albumin, alanine aminotransferase, aspartate aminotransferase, bilirubin, prothrombin time and activity, international normalized ratio, complete blood count, total leukocytic count, C-reactive protein (CRP), hepatitis C virus antibodies, hepatitis B surface antigen, and pelvic-abdominal ultrasonography. Results AKI was found in 43.6% of the cirrhotic patients studied. The most predominant type was the prerenal AKI. Hepatorenal syndrome was found in 25.2% of patients. Septic causes included (spontaneous bacterial peritonitis in 24.2% of patients, chest infection in 22.6%, and urinary tract infection in 18.6%). Upper gastrointestinal bleeding was reported in 13% of cases. Postrenal causes were reported in 4.3% of cases, while intrinsic renal causes were found in 1% of cases. In 5.3% of cases, the cause of AKI was unidentified. We found that hemoglobin and serum albumin were significantly lower in patients with AKI compared with those without AKI. We found a significant positive correlation between serum creatinine and each of the following laboratory parameters: total leukocytic count, CRP, and international normalized ratio. On the other hand, we found a significant negative correlation between serum creatinine and hemoglobin and serum albumin. The CRP was the most independent risk factor in our patients. Conclusion AKI incidence in cirrhotic patients is significantly high. Prerenal AKI is the most predominant type. Sepsis was the most important prerenal causes of AKI in our cirrhotic patients. Anemia, hypoalbuminemia, hyperbilirubinemia, gastrointestinal bleeding, and sepsis increase the risk of AKI among cirrhotic patients.